This application is based upon and claims the benefit of priority from the prior Japanese Patent Applications No. 11-266687, filed Sep. 21, 1999; No. 11-288328, filed Oct. 8, 1999; No. 11-298250, filed Oct. 20, 1999; No. 11-312443, filed Nov. 2, 1999; No. 11-353212, filed Dec. 13, 1999; No. 11-354414, filed Dec. 14, 1999, the entire contents of which are incorporated herein by reference.
The present invention relates to a surgical microscopic system adapted for microsurgery carried out under microscopic observation for neurosurgery, for example.
In order to ensure higher accuracy for a neurosurgical operation that uses an operating microscope, for example, treatment based on an endoscope, ultrasonic diagnostic apparatus, or any other diagnostic technique without the use of visible light is expected to be carried out for the tissues of regions that are not accessible to the operating microscope, such as the back or inside of an affected region, accompanied by real-time observation and diagnosis. Various surgical microscopic systems have been developed to meet this requirement.
Described in Jpn. Pat. Appln. KOKAI Publications Nos. 62-166310, 3-105305, 7-261094 are surgical observational systems in which an endoscope or the like is used to observe regions that correspond to dead angles of an operating microscope, and optical images of the observational regions are projected in the field of the microscope.
According to these conventional surgical observational systems, however, an observational image obtained by means of the endoscope or the like is only projected on the microscopic field, so that it is difficult for an operator to identify the endoscopic image that is actually observed through the field of the microscope. In the case where this technique is applied to a diagnostic apparatus, such as an ultrasonic diagnostic apparatus, which uses no visible light, the operator can hardly grasp an actually diagnosed part of a patient""s body according to an image in the observational field only. Thus, the operator can discriminate the diagnosed region by the image only if s/he ideally superposes the characteristic features of the diagnostic image and the actual observational image, based on his or her experience.
Described in Jpn. Pat. Appln. KOKAI Publication No. 9-56669, moreover, is a surgical microscopic system with improved operativity, in which an endoscopic image or the like is displayed as a sub-picture in some other part of the microscopic field than the field portion where a main observational image is displayed. If the operator uses the system in combination with an endoscope or ultrasonic observer in this case, however, s/he is not provided with any means for grasping the region that is observed actually. Therefore, the operator can grasp the observational region only by randomly swinging the endoscope or ultrasonic probe in all directions and ideally superposing the characteristic features in comparison with a microscopic image.
Further, a method for guiding second observational means, such as an ultrasonic probe, into the field of an operating microscope is described in Jpn. Pat. Appln. KOKAI Publication No. 6-209953. According to this conventional technique, however, there is provided no method for effectively displaying the observational image of the second observational means in the microscopic field, so that the operator can correlate the microscopic optical image and the image of the second observational means only ideally.
Proposed in Jpn. Pat. Appln. No. 11-132688 filed by the assignee of the present invention (not published), furthermore, is a surgical microscopic system in which the direction of the observational field of an endoscope is indicated by an arrow or the like displayed in the field of a microscope. However, the microscopic optical image and the endoscopic image cannot be satisfactorily correlated by only indicating the observational direction in this manner. Thus, the operator can correlate these images only ideally in consideration of differences in rotation, magnification, etc. between them. If an ultrasonic observer is used as auxiliary observational means, moreover, the observational direction is not fixed, covering the circumferential angle of 360xc2x0, for example, so that it is hard to align observational image and an actual affected region.
Described in Jpn. Pat. Appln. KOKAI Publication No. 6-205793, moreover, is a display system that displays a preoperative diagnostic image by superposition on an image of an affected region by means of a half-mirror. Since the preoperative diagnostic image is superposed on the whole affected region image in this case, however, the microscopic field is too obscure to ensure a satisfactory actual surgical operation. Therefore, this system can only determine a preoperative position for craniotomy, and cannot accurately grasp information on the inner tissue in association with the affected region on a real-time basis during the surgical operation.
Described in Jpn. Pat. Appln. KOKAI Publication No. 9-24052, furthermore, is a method that uses fluorescent observation for the recognition of the position of a cerebral tumor, in order to extract the tumor securely under surgical microscopic observation. Although the observational tumor position can be securely recognized by this method, however, the obtained information is related only to the exposed surface of the tumor on the plane of observation at that time (during the extraction). Accordingly, information on the entire tumor (including information on inaccessible depths) inevitably depends on preoperative information.
Further, a navigation apparatus is proposed in Jpn. Pat. Appln. No. 10-248672 (not published). This navigation apparatus forms three-dimensional image data on the basis of image information from a CT scanner or MRI that is operated for a preoperative diagnosis, establishes a spatial correlation between a patient""s head and the observational position of a microscope during a surgical operation, and supports the surgical operation in accordance with the three-dimensional image data. According to this navigation apparatus, the image of the entire tumor is obtained as slice image information for the observational point concerned during the surgical operation. However, only the slice image information for a focal position can be obtained on a three-dimensional observational plane of the operating microscope. Therefore, the operator must identify the position of the tumor by the slice image information with the progress of the operation.
With the recent development and spread of microsurgery, a technique for surgical operations for minute affected regions, moreover, operating microscopes have started to be extensively used for microsurgery in a wide variety of fields including ophthalmology, neurosurgery, otolaryngology, etc. Naturally, therefore, the operating microscopes are being improved to meet various requirements that depend on operators"" surgical maneuvers. Recently, surgical operations have been changed into less invasive ones in consideration of earlier rehabilitation of operated patients, so that there is a demand for the way of observation of affected regions in finer tubules. For improved accuracy and safety of surgical operations in the depths of the body cavity, furthermore, hidden regions that are inaccessible to microscopic observation are expected to made observable.
As a technique to meet these requirements, a stereoscopic operating microscope described in Jpn. Pat. Appln. KOKAI Publication No. 62-166310, for example, is designed so that the inside of a tubule can be observed by means of first and second stereoscopic optical systems with different base line intervals. Since the two stereoscopic optical systems shares a finder optical system, moreover, an operator can alternatively observe images from the two optical systems. This stereoscopic operating microscope is provided with the stereoscopic optical system that includes the finder optical system and a pair of variable-magnification optical systems, left and right, having the same optical axis. An auxiliary stereoscopic optical system that is located near the main stereoscopic optical system includes image restoring means for reproducing an image from a solid-state image-pickup device for picking up an image of an observed object and image projecting means for guiding the image to the finder optical system of the stereoscopic optical system.
An optical device described in Jpn. Pat. Appln. KOKAI Publications No. 3-105305 is designed so that one or both of images from two observational means of a stereoscopic operating microscope can be alternatively observed and that the operator can select the images by means of a footswitch or the like without using his or her hand.
A system described in Jpn. Pat. Appln. KOKAI Publication No. 6-175033, moreover, is provided with position specifying means for specifying a position in or near the observational field. In this system, the relation between a reference position of an operating microscope and the position specified by means of the position specifying means is computed, and the body of the microscope is moved to the specified position.
Described in Jpn. Pat. Appln. No. 10-319190 filed by the assignee of the present invention (1998, not published), furthermore, is a system provided with drive means that causes an operating microscope and a robot manipulator to move to target positions in accordance with a preoperative diagnostic image or slice image information, thereby correlating the preoperative image and the operative field.
If the operator uses an auxiliary optical system for tubule observation to observe dead-angle regions that are inaccessible to microscopic observation, e.g., the back side of the an aneurysm, nerves cleared of a tumor, peripheral tissues, etc., as in the prior art case mentioned before, a video image picked up by means of an endoscope or other auxiliary optical system is displayed in the microscopic field. In this case, the operator""s mate sometimes may observe a similar image as s/he aspirates the marrow or blood to secure the operator""s field of vision.
FIGS. 74 shows an example of the system of an operating microscope a of this type. A body b of the microscope a is provided with an operator eyepiece unit c1 and a mate eyepiece unit c2. An in-field monitor (not shown) is located in a part of the field of each of the eyepiece units c1 and c2. As shown in FIGS. 75A and 75B, indexes and sub-images e1 and e2 that are different from main images d1 and d2 of the operating microscope a are projected in the main images d1 and d2.
An LCD driver f is connected to each in-field monitor. Further, a CCTV unit g is connected to the LCD driver f. A camera head i is connected to the CCTV unit q. An endoscopic image observed by means of an endoscope h is displayed on the respective in-field monitors of the operator and mate eyepiece units c1 and c2.
When a conventional operating microscope apparatus is used, moreover, an operative field j as an object of a surgical operation is observed at different angles by means of the microscope body b and the endoscope h. An optical video image then caught by the endoscope h is photoelectrically converted by means of a image-pickup device (not shown) in the TV camera head i and applied as an electrical signal to the TV camera head i to be processed therein, whereupon a TV signal is outputted. This TV signal is converted into a display mode signal of a liquid crystal display device (not shown) by means of the LCD driver f. This signal is delivered to liquid crystal image display devices (not shown) of the respective in-field monitors of the operator and mate eyepiece units c1 and c2 of the microscope a. Thereupon, endoscopic images are partially displayed as the sub-images e1 and e2 on the main images d1 and d2 of the microscope a in the microscopic field, as shown in FIGS. 75A and 75B. More specifically, in the operator eyepiece unit c1 of this operating microscope apparatus, the sub-image e1, an endoscopic image, is inserted into the main image d1 in the field of the microscope a by means of the liquid crystal image display device (not shown), as shown in FIG. 75A. Likewise, in the mate eyepiece unit c2, the sub-image e2, an endoscopic image, is inserted into the main image d2 in the field of the microscope a by means of the liquid crystal image display device (not shown), as shown in FIG. 75B.
According to this operating microscope apparatus, however, the operator and the mate have their respective observational directions. Therefore, the relation between the display position of the main image d1 in the field of the operator eyepiece unit c1 of the microscope a and the display position of the sub-image e1 in the same field is different from the relation between the display position of the main image d2 in the field of the mate eyepiece unit c2 of the microscope a and the display position of the sub-image e2 in the same field. Since the field direction of the mate is different from that of the operator, the position in the mate-side observational optical system where the in-field display image appears is inevitably different from the corresponding position in the operator-side observational optical system. Possibly, therefore, a region that can be observed through the operator-side optical system may not be able to be observed through the mate-side optical system.
Basically, moreover, the field direction on the mate side is different from the operator-side field direction. Although the microscope images are located in correct relative positions, therefore, the positional relation between the images obtained by means of the auxiliary optical system cannot be displayed correctly. Since the mate-side observational optical system is rotatable with respect to the operator-side system, furthermore, the positional relation between the images of the auxiliary optical system goes wrong if the mate-side system is rotated. If bleeding or the like occurs in any region corresponding to a dead angle of the image of the auxiliary optical system in the mate-side field, therefore, the display position of the auxiliary optical system must be controlled manually.
In carrying out a surgical operation with reference to a diagnostic image, furthermore, a preoperative diagnostic image, such as MRI or X-ray CT, sometimes may be display as each of the sub-images e1 and e2 on the video images in the main images d1 and d2 in the field of the microscope a. In this case, these sub-images, unlike the aforesaid video image of the auxiliary optical system, should never fail to be erect images, and the images that are accessible to the operator and the mate, individually, must be of the same type.
In the case where the operating microscope apparatus is used in combination with a position information detector or the like, moreover, a position information detection image and a marker for the detector must be overlaid on a microscopic image. A conventional microscopic apparatus with in-field display means requires use of one combination of an optical system and a display device for the display of an image in the microscopic field and another for the display of a marker. If the image and the marker are needed simultaneously, therefore, the display device must be changed during use or one of the devices must be replaced with an alternative device.
Conventionally, furthermore, the operator is expected to confirm the marker display of the position information detector and manually move the microscope body to the marker position. Accordingly, highly complicated maneuvers are required by a technique that uses the position information detector in combination with an auxiliary optical system such as an endoscope.
In order to make a microsurgical operation less invasive, moreover, various pieces of image information are used during the operation. The image information may be obtained by means of an endoscope for observing regions that are inaccessible to the operating microscope or an ultrasonic observer for obtaining a slice image of the inside of tissue. Further, it may be obtained by means of a diagnostic device such as a so-called nerve monitor device for measuring the potential of nerves of a patient under the operation. To attain this, an operating microscope for the observation of an endoscopic image or the like is described in Jpn. Pat. Appln. KOKAI Publication No. 10-333047, as in Jpn. Pat. Appln. KOKAI Publication No. 62-166310.
A microscope requires visibility adjustment or adjustment of differences in eyesight (refractive force) between observers. A technique for this visibility adjustment is described in Jpn. Pat. Appln. KOKAI Publication No. 7-281103. An operating microscope is also subjected to the visibility adjustment with every surgical operation. On the other hand, a method for measuring the refractive force of an eye is described in Jpn. Pat. Appln. KOKAI Publication No. 3-200914. In this method, however, the refractive force of an eye of a patient, not an observer, is measured by projecting an index on the eyeground and detecting light reflected by the eyeground.
The operating microscope described in Jpn. Pat. Appln. KOKAI Publication No. 10-333047 can perform microscopic observation and endoscopic observation in one and the same field. When an endoscope is moved in an affected region, however, its distal end must be checked for the location on a microscopic image lest it damage tissue as an endoscopic image is observed. It is to be desired, therefore, that the endoscopic image should not intercept the microscopic field or should be displayed small on the microscopic image.
When the endoscopic image is watched as a treatment or the like is carried out, on the other hand, it is expected to be wide enough. Observation based on the microscopic image is also needed to check an instrument for insertion or watch a wide range of the affected region. Thus, it is advisable to display the endoscopic image large on the microscopic image.
In each of the operating microscopes described in Jpn. Pat. Appln. KOKAI Publications Nos. 62-166310 and 10-333047, however, the endoscopic image is displayed in a fixed position and within a fixed range in the microscopic field. Therefore, a surgical operation using the endoscope cannot easily meet the demand for both the movement of the endoscope and the treatment with reference to the endoscopic image, and the endoscopic image may be obstructive or too small for smooth treatment.
Thus, it is hard for an operator to concentrate his or her attention on the surgical operation, so that the operator""s fatigue increases, and the operation time extends. An ultrasonic diagnostic apparatus is subject to the same problems when its probe is moved or when ultrasonic observation or treatment under ultrasonic observation is carried out. Since the endoscope used under surgical microscopic observation is designed for the observation of regions corresponding to dead angles of the microscope, moreover, it should be of a squint type for observation in directions different from the direction of its insertion. If the squint-type endoscope is rotated around the direction of insertion, it ceases to be able to identify the direction of view with respect to the microscopic field. Accordingly, the operator must judge the observational direction by a tissue form displayed in the endoscopic image. Thus, it is hard for the operator to be devoted to the surgical operation, so that the operator""s fatigue increases, and the operation time extends. Even when the operator is concentrating his or her attention on the observational image of the operating microscope, furthermore, s/he must also pay attention to the state of some other equipment to detect a change in the nerve monitor device, so that his or her fatigue is increased.
On the other hand, the conventional visibility adjustment operation described in Jpn. Pat. Appln. KOKAI Publication No. 7-281103 is troublesome and lengthens the setup time before the start of operation of the operating microscope. If the operator changes during a surgical operation, moreover, the visibility must be readjusted. Usually, it is difficult to adjust the visibility with a drape for sterilization on the microscope. If the microscope is used with wrong visibility, the surgical operation is performed with the right or left eye of the operator out of focus, so that the operator is fatigued much. Further, a TV camera or 35-mm camera that is connected to the operating microscope may fail to be in focus. In this case, the refractive index of the operator""s eye may be able to be measured automatically to correct the visibility by the method described in Jpn. Pat. Appln. KOKAI Publication No. 3-200914. According to this method, however, an optical system must be provided with an index projection optical system for detection and its mating light receiving optical system, so that a large-sized apparatus is required, constituting a hindrance to the surgical operation. Even if projected light has a wavelength in an invisible zone, its influence upon the observational performance of the microscope cannot be removed thoroughly, so that the efficiency of the surgical operation is lowered, and the operator is fatigued inevitably.
A rigid scope may be used for the observation of regions corresponding to dead angles of the operating microscope in microsurgery. In this case, the observation of the dead-angle regions requires use of a so-called squint-type rigid scope for oblique observation at a fixed angle (e.g., 30xc2x0, 70xc2x0 or 110xc2x0) to the observational optical axis of its eyepiece. In this rigid scope, a TV camera (image-pickup device) is connected to the eyepiece to display its observational image on a monitor screen. The rigid scope is also connected with a light guide, which is connected to a light source unit to guide illumination light to an affected region. In order to observe a region corresponding to a dead angle of the operating microscope, the rigid scope of this type is used in a very narrow space (normally about 300 mm) between the body of the microscope and the observational region. To change its squint angle, moreover, the rigid scope can be rotated throughout the angular range of 360xc2x0 with respect to the direction of its insertion during a surgical operation. Thus, the operator can observe his or her desired position.
In a rigid scope described in Jpn. UM Appln. KOKAI Publication No. 5-78201, a TV camera is connected optically to the imaging point of its eyepiece. A light guide that constitutes an illumination optical system in the rigid scope and a light guide one end of which is connected to a light source unit are connected optically to each other in a position near the eyepiece. Since the TV camera itself projects in the direction of insertion of the rigid scope, however, it may possibly interfere with the operating microscope body, depending on the direction of insertion of the scope into the body cavity, so that the operator""s desired observational position is restricted inevitably. Further, the light guide that is connected to the light source unit projects substantially at right angles to the direction of insertion into the body cavity. If the operator rotates the rigid scope around the direction of insertion to change the observational direction, therefore, the light guide may get deep into the field of the microscope depending on its direction, thereby hindering the microscopic observation.
In a rigid scope described in U.S. Pat. No. 5,168,863, moreover, cables of a TV camera that is connected to an eyepiece are guided in a direction at about 45xc2x0 to its longitudinal direction (direction of insertion into the body cavity). In this case, the TV camera can somewhat be prevented from interfering with the body of an operating microscope. Nevertheless, the TV camera itself still causes interference, and the light guide extensively intercepts the microscopic field as the rigid scope rotates.
In a rigid scope described in Jpn. UM Appln. KOKAI Publication No. 56-176703, furthermore, a reflective member for bending the observational optical axis is disposed on an observational optical system therein so that the optical axis of an eyepiece is inclined at a fixed angle to the longitudinal direction of the scope (direction of insertion into the body cavity). Since the a part of the eyepiece portion of this rigid scope is inclined at the fixed angle to the direction of insertion of the scope, a TV camera can avoid interfering with the body of an operating microscope. Since the direction of projection of a light guide is coincident with the direction of insertion into the body cavity, however, the light guide and the microscope body inevitably interfere with each other.
A rigid scope described in Jpn. Pat. Appln. KOKAI Publication No. 11-155798, like the one described in Jpn. UM Appln. KOKAI Publication No. 56-176703, is designed so that the observational optical axis of an eyepiece is inclined at a fixed angle to its longitudinal direction (direction of insertion into the body cavity), and a light guide, which is connected to a light source unit, is connectable near the eyepiece. In either of the rigid scopes described in Jpn. UM Appln. KOKAI Publication No. 56-176703 and Jpn. Pat. Appln. KOKAI Publication No. 11-155798, however, the eyepiece and the TV cam attached thereto project long within a plane at about 90xc2x0 to the direction of insertion of the rigid scope into the body cavity (i.e., region for the operator""s surgical operation), so that they inevitably intercept the space for the surgical operation, thereby hindering the operation. When the operator rotates the rigid scope around the direction of insertion into the body cavity to change the observational direction, in particular, the scope moves in an arc of a circle having a radius that is equal to the sum of the respective overall lengths of the eyepiece, TV camera, cables, etc., thus constituting a great hindrance to the operation. Depending on the observational direction, moreover, the TV camera and the light guide may interfere with the operator""s hand or body, so that they may possibly lower the efficiency of the surgical operation.
The present invention has been contrived in consideration of these circumstances.
An object of the present invention is to improve the efficiency of a surgical operation by simultaneously displaying a plurality of pieces of information required by an operator in the field of a microscope during microsurgery so that the operator can be fed with necessary information as required.
Another object of the invention is to display a real-time observational image of second observational means effectively in association with an observational image of first observational means in the field of the first observational means in a microscope body.
Still another object of the invention is to provide a surgical microscopic system designed so that an operator can easily grasp the progress of an surgical operation during the operation, whereby the operation can be carried out more securely and safely.
A further object of the invention is to provide a surgical microscopic system designed so that necessary in-field information can be appropriately offered to an operator or his or her mate, and that a required microscopic field can be easily secured during a surgical operation.
An additional object of the invention is to provide a surgical microscopic system designed so that an operator can be devoted to a surgical operation, his or her fatigue can be eased, and the operation time can be shortened.
Furthermore, the invention is intended to improve a rigid scope that can be inserted into the body cavity under surgical microscopic observation, thereby enabling observation at a fixed angle to the direction of insertion, to prevent the rigid scope and a TV camera or light guides connected thereto from hindering the microscopic observation or surgical treatment, and to enable an operator to observe a desired position with ease.
In order to achieve the above objects, according to an aspect of the invention, there is provided an operating microscope apparatus comprising: at least one microscope body defining an observational field for observing an affected region; first image display means for displaying a first image in the observational field; second image display means for displaying a second image in the observational field; and image display control means for displaying independent images on the first and second image display means, individually.
The microscope body may include an optical image displayed in the observational field. In this case, the operating microscope apparatus may comprise second observational means different from an operating microscope and selected from a group including an endoscope and an ultrasonic probe. Further, the second image display means may include an image superposition optical system for superposing an image on the optical image in the observational field. Preferably, the image display control means includes means for independently switching on and off the first and second image display means.
In the case where the operating microscope apparatus comprises second observational means different from an operating microscope and selected from a group including an endoscope and an ultrasonic probe, the first and second images preferably include (i) a combination of an observational image obtained by means of the second observational means and an image (navigation image) indicative of the observational position or direction of the second observational means or (ii) a combination of a tumor position display marker image and a preoperative/mid-operative diagnostic image selected from a group including image-processed fluorescent observational images and the image (navigation image) indicative of the observational position or direction of the second observational means.
According to another aspect of the invention, there is provided a surgical observational system including first observational means for observing an affected region and second observational means different from the first observational means at least in the observational direction or observational method. This system comprises detecting means for detecting the respective observational positions and directions of the first and second observational means relative to the position of the affected region; and display means for displaying an observational image of the second observational means in a given part of an observational image of the first observational means in visual correlation based on the relative positions detected by means of the detecting means. According to this surgical observational system, the image of the second observational means is correlatively displayed in a part of the observational image of the first observational means. Thus, the respective observational positions of the first and second observational means are detected on the basis of the affected region by means of an optical position detector, for example. The observational image of a corresponding portion of the second observational means can be cut out into a given position of the observational image of the first observational means to adjust the image size for display.
Alternatively, the surgical observational system may comprise detecting means for previously storing a preoperative diagnostic image and detecting the observational position of the second observational means relative to the preoperative diagnostic image; and display means for simultaneously displaying the preoperative diagnostic image concurrent with the observational position of the second observational means and the observational image of the second observational means in the field of the first observational means in accordance with the relative positions detected by means of the detecting means. In this case, the observational position of the second observational means is detected on the basis of the affected region by means of an optical position detector, for example. The observational image of the second observational means is displayed in the field of the observational image of the first observational means, and at the same time, a part of the preoperative diagnostic image corresponding to the observational position of the second observational means is displayed in the observational field of the first observational means.
According to this surgical observational system, at least a part of the observational image of the second observational means is displayed in the observational field of the first observational means for the observation of the affected region in a manner such that its position, size, etc. are associated with those of the observational field of the first observational means. Accordingly, the states of dead angle portions and the inside of tissue that cannot be observed by means of the first observational means can be recognized easily and securely, so that the reliability and efficiency of the surgical operation can be improved considerably.
On the other hand, the surgical observational system may comprise detecting means for detecting the respective observational positions and directions of the first and second observational means relative to the position of the affected region; an indicator indicative of an optional position in the observational field of the first observational means; and display means capable of following the indicator and displaying an observational image for a given range in the observational field of the first observational means by superposition. According to this surgical observational system, as in the case of the system described above, the image of the second observational means can be correlatively displayed in a part of the observational image of the first observational means. An operator can operate the indicator to set an optional position in the observational field of the first observational means. The observational image of the second observational means is displayed in a given range of the indicator after is cut out and subjected to size adjustment. Thus, the affected region in the peripheral portion and the observational image of the second observational means can be correlated with ease, and treatment can be carried out smoothly, so that the efficiency of the surgical operation can be improved.
According to still another aspect of the invention, there is provided an operating microscope apparatus for subjecting an affected region to a surgical operation, comprising: a microscope body including a stereoscopic optical system and used to observe a desired region; position computing means for detecting the position of the observational region observed through the stereoscopic optical system and computing the positional relation between the observational region and a diagnostic image of the affected region; fluorescent shooting means for shooting fluorescent images of the observational region, thereby obtaining fluorescent observational images; and display means for displaying, by superposition, the diagnostic image corresponding to the position of the observational region detected by means of the position computing means and the fluorescent observational images obtained by means of the fluorescent shooting means.
This operating microscope apparatus may comprise storage means for storing the fluorescent observational images. In this case, the display means displays the diagnostic image corresponding to the observational position detected by means of the position computing means and the fluorescent observational images stored in the storage means, by superposition on the observational image of the affected region. Further, the operating microscope apparatus may comprise display mode setting means capable of setting an optional display mode. In this case, the display means displays the diagnostic image corresponding to the observational position detected by means of the position computing means and the fluorescent observational images stored in the storage means, by superposition on the observational image of the affected region, in accordance with the setup state of the display mode setting means.
According to this operating microscope apparatus, the fluorescent observational images shot by means of the fluorescent shooting means and the diagnostic image selected according to the observational position detected by means of the position computing means are displayed by superposition, so that the operator can accurately recognize the conditions of a tumor to be extracted. Thus, the operator can carry out extraction more accurately and be devoted to the extracting operation. Further, only the tumor portion can be extracted securely, so that the object for minimally invasive surgery can be achieved.
According to the present invention, moreover, there is provided an operating microscope apparatus for subjecting an affected region to a surgical operation, comprising: a microscope body including a stereoscopic optical system and used to observe a desired region; position computing means for detecting the position of the observational region observed through the stereoscopic optical system and computing the positional relation between the observational region and a diagnostic image of the affected region; fluorescent shooting means for stereoscopically shooting fluorescent images of the observational region, thereby obtaining fluorescent observational images; storage means for storing the fluorescent observational images; image dividing means for dividing the diagnostic image corresponding to the observational position detected by means of the position computing means into two image signals having a lateral parallax; and display means for displaying the individual stored fluorescent observational images and the laterally divided diagnostic images by superposition on the observational image of the affected region.
Likewise, there is provided an operating microscope apparatus for subjecting an affected region to a surgical operation, comprising: a microscope body including a stereoscopic optical system and used to observe a desired region; position computing means for detecting the position of the observational region observed through the stereoscopic optical system and computing the positional relation between the observational region and a diagnostic image of the affected region; fluorescent shooting means for stereoscopically shooting fluorescent images of the microscopic observational region, thereby obtaining fluorescent observational images; storage means for storing the fluorescent observational images; display mode setting means capable of setting an optional display mode; image dividing means for dividing the diagnostic image corresponding to the observational position detected by means of the position computing means into two image signals having a lateral parallax; superposing means for superposing the individual stored fluorescent observational images and the laterally divided diagnostic images on the observational image of the affected region in accordance with the setup state of the display mode setting means; and a lens tube portion having a monitor portion for displaying the individual images.
The fluorescent shooting means may be designed for stereoscopic shooting of the fluorescent images of the observational region. In this case, the operating microscope apparatus comprises image dividing means for dividing the diagnostic image corresponding to the observational position detected by means of the position computing means into two image signals having a lateral parallax. The display means can display the individual stored fluorescent observational images and the laterally divided diagnostic images by superposition on the observational image of the affected region.
Further, the operating microscope apparatus may comprise a lens tube portion having a monitor portion for displaying the individual images.
Furthermore, the display means may be designed to display, by superposition, the slice image corresponding to the observational position detected by means of the position computing means and the fluorescent observational images obtained by means of the fluorescent shooting means. This operating microscope apparatus may comprise display mode setting means capable of setting an optional display mode. In this case, the display means displays the slice image corresponding to the observational position detected by means of the position computing means and the fluorescent observational images stored in the storage means, by superposition on the observational image of the affected region, in accordance with the setup state of the display mode setting means.
According to a further aspect of the invention, there is provided an operating microscope apparatus including a plurality of eyepiece units capable of relative movement and individually having fields capable of displaying one and the same region as a main image and in-field monitors provided individually for the eyepiece units and each adapted to project an index and/or a sub-image different from the main image on a part of the field, comprising: input means for applying observation conditions to one of the eyepiece units; and observational state changing means for changing the observational state of the other eyepiece unit according to the conditions. Thus, necessary in-field information can be appropriately offered to the operator or his or her mate, and a target microscopic field can be easily secured during a surgical operation. Preferably, the observational state changing means includes detecting means for detecting the position of the one eyepiece unit relative to the other eyepiece unit, an in-field display control means for controlling the display position of the in-field monitor of at least the one eyepiece unit to change the observational region in accordance with the result of detection by the detecting means, shielding means for selectively intercepting the optical image of the eyepiece units, and image rotating means for rotating the image of the in-field monitor in response to the output of the position detecting means. In this case, an optimum image display method can be provided even for a fixed-direction image, such as a preoperative image, and overlay display of the index by means of a position information detector and the operation of the detector can be carried out with ease. Further, the display method can secure a satisfactory degree of freedom for the operator and the mate.
The sub-image may be a diagnostic image. Preferably, in this case, the operating microscope apparatus comprises index manipulating means for changing the in-field index position on the diagnostic image and a position information computing unit for computing the three-dimensional position of an actual affected region relative to the position of the index displayed by means of the index manipulating means, and the position information computing unit and the in-field display control means drive the observational region of the operating microscope to the three-dimensional position.
Preferably, the operating microscope apparatus further comprises an image processing unit for image map conversion, adapted synchronously to rotate the image of the in-field monitor and the shielding means formed of the liquid crystal device in response to the output of the relative position detecting means.
According to an additional aspect of the invention, there is provided an operating microscope comprising: a first observational optical system for optically enlarging an affected region; a second observational optical system for observing optional image information from an external apparatus; and an eyepiece optical system for simultaneously observing observational images of the first and second observational optical systems, the second optical system including display state changing means capable of changing the display state of the image information from the external apparatus in accordance with operation information from the external apparatus. The first and second observational optical systems are different from each other.
According to this operating microscope, if the operating state of the external apparatus is changed when the observational images of the first and second observational optical systems are simultaneously displayed, the image observed by means of the second observational means is automatically changed into a suitable state for a surgical operation. A small endoscopic image is displayed when an endoscope is moved in the affected region, for example. The displayed endoscopic image is large enough when it is watched as treatment or the like is carried out. Thus, according to this operating microscope, the display state of the display image in the microscopic field can be automatically changed in accordance with the operating state of the external apparatus, so that the operator can be devoted to the surgical operation, his or her fatigue can be eased, and the operation time can be shortened. This microscope is particularly serviceable if it is used with an ultrasonic observer for obtaining a slice image of the inside of tissue or a so-called nerve monitor device for measuring the potential of nerves of a patient under the operation, as well as the endoscope for observing regions that are inaccessible to the operating microscope.
Further, there is provided an operating microscope comprising: a first observational optical system for enlarged-scale optical observation of an affected region; a second observational optical system for observing optional image information from an external apparatus, the second observational optical system being different from the first observational optical system, and an eyepiece optical system for simultaneously observing observational images of the first and second observational optical systems. The second optical system includes fixed-view image display means for an observer""s close observation, an index projection optical system for the eyeground, and an image receiving optical system for receiving reflected light from the eyeground. The operating microscope further comprises detecting means for computing refractive force in accordance with information from the image receiving optical system and visibility adjustment drive control means for driving a visibility adjustment mechanism in accordance with information from the detecting means. According to this operating microscope, the sight or refractive force of an observing eye is measured through the second observational optical system. Based on this refractive force, the visibility adjustment drive control means automatically carries out visibility adjustment. Thus, the operating microscope can be reduced in size without lowering its observational performance, and the operator can concentrate his or her attention on the operation without fatigue.
The display state changing means may include operation input portion for inputting the operation information from the external apparatus, optical changing means capable of optically changing the display state of the image information of the second observational optical system compared to the observational image of the first observational optical system, and control means for actuating the optical changing means in accordance with input information from the operation input portion. Preferably, the optical changing means includes magnification changing means capable of changing the magnification of the second observational optical system. According to this operating microscope, the size of each endoscopic image in the microscopic field can be changed in accordance with the movement and observational state of the endoscope. Thus, when the endoscope is moved, a small endoscopic image is displayed such that the distal end of the endoscope can be satisfactorily observed through the microscope. During endoscopic observation, on the other hand, a large image is displayed to facilitate treatment. If a squint-type endoscope for observation in directions different from the direction of insertion is used and rotated around the direction of insertion to observe regions corresponding to dead angles of the microscope, therefore, the observational direction of the endoscope compared to the microscopic field can be identified with ease.
Preferably, the optical changing means includes magnification changing means capable of changing the magnification of the second observational optical system or display position changing means capable of changing the position of the second observational optical system relative to the first observational optical system. The magnification changing means may be lens moving means for moving a variable-magnification optical system constituting the second observational optical system. Thus, there is provided an operating microscope in which the observational direction of an endoscope compared to the microscopic image can be recognized with ease.
The display position changing means may include rotating means for rotating the second observational means around the optical axis of the first observational means. Even when the operator is concentrating his or her attention on the observational image of the operating microscope, in this case, s/he can readily notice a change in the nerve monitor device. Thus, the operator can be devoted to the surgical operation, and his or her fatigue can be eased.
Additional objects and advantages of the invention will be set forth in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention. The objects and advantages of the invention may be realized and obtained by means of the instrumentalities and combinations particularly pointed out hereinafter.